Detailed metabolic evaluation and prophylaxis for all patients presenting with a first renal stone seems inappropriate. The crucial clinical problem lies in predicting which patients are likely to have a recurrence. Stone composition is an important guide for the physician's decisions concerning investigation and a rational choice of treatment.
HCV appears to cause chiefly an asymptomatic chronic infection, which is nonetheless linked to a heightened prevalence of "essential" mixed cryoglobulinemia. The monoclonal rheumatoid factor occurring in the disease may result from chronic stimulation of the immune system, perhaps by the virus directly.
As many as two thirds of patients with new symptoms after documented DVT have postphlebitic syndrome, not DVT. Noninvasive imaging is central to the differentiation so that unnecessary anticoagulation therapy can be avoided. Recent changes in heparin and warfarin protocols for DVT are also outlined.
Loss of tolerance to self-antigens is thought to have a role in a variety of common diseases. Studies in animal models of such diseases as systemic lupus erythematosus have provided new insights into how self-tolerance is broken or bypassed and how it may be restored. These and other experiments also are clarifying how self-tolerance is normally established; the T lymphocyte appears to be the dominant player.
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